Active NPI
Martin Ivan Broder, MD
- Cardiovascular Disease Physician
- Pittsfield, MA
National Provider Identifier
1316991318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 48703
- Practice address
- 777 North St
Cardiology
Pittsfield, MA 01201-4147 - Phone
- (413) 395-7580
- Fax
- (413) 499-8539
- NPI assigned
- May 22, 2006
- Last updated
- Oct 28, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 48703 | MA | Primary |
Addresses
Primary practice location
777 North St
Cardiology
Pittsfield, MA 01201-4147
Mailing address
725 North St
Pittsfield, MA 01201
Phone (413) 447-2752
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6193803 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48703 | MA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berkshire Faculty Services Inc | Past | Accepting new patients | |
| Fairview Hospital | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Pittsfield, MA
- NPI 1548212939
-
dba East Mountain Medical
- Rural Health Clinic/Center
- Great Barrington, MA
- NPI 1881252286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288224000000",
"number": "1316991318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 NORTH ST",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "01201",
"telephone_number": "413-447-2752",
"fax_number": "413-496-6836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 NORTH ST",
"address_2": "CARDIOLOGY",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "012014147",
"telephone_number": "413-395-7580",
"fax_number": "413-499-8539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODER",
"first_name": "MARTIN",
"middle_name": "IVAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2010-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MA",
"license": "48703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6193803",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.